title: Reiki and related therapies in the dialysis ward: an evidence-based and ethical discussion to debate if these complementary and alternative medicines are welcomed or banned.
abstract: BACKGROUND
  Complementary and Alternative Medicines (CAMs) are increasingly practiced in the general population; it is estimated that over 30% of patients with chronic diseases use CAMs on a regular basis. CAMs are also used in hospital settings, suggesting a growing interest in individualized therapies. One potential field of interest is pain, frequently reported by dialysis patients, and seldom sufficiently relieved by mainstream therapies. Gentle-touch therapies and Reiki (an energy based touch therapy) are widely used in the western population as pain relievers.By integrating evidence based approaches and providing ethical discussion, this debate discusses the pros and cons of CAMs in the dialysis ward, and whether such approaches should be welcomed or banned.
  
  
  CONCLUSIONS
  In spite of the wide use of CAMs in the general population, few studies deal with the pros and cons of an integration of mainstream medicine and CAMs in dialysis patients; one paper only regarded the use of Reiki and related practices. Widening the search to chronic pain, Reiki and related practices, 419 articles were found on Medline and 6 were selected (1 Cochrane review and 5 RCTs updating the Cochrane review). According to the EBM approach, Reiki allows a statistically significant but very low-grade pain reduction without specific side effects. Gentle-touch therapy and Reiki are thus good examples of approaches in which controversial efficacy has to be balanced against no known side effect, frequent free availability (volunteer non-profit associations) and easy integration with any other pharmacological or non pharmacological therapy. While a classical evidence-based approach, showing low-grade efficacy, is likely to lead to a negative attitude towards the use of Reiki in the dialysis ward, the ethical discussion, analyzing beneficium (efficacy) together with non maleficium (side effects), justice (cost, availability and integration with mainstream therapies) and autonomy (patients' choice) is likely to lead to a permissive-positive attitude.
  
  
  CONCLUSIONS
  This paper debates the current evidence on Reiki and related techniques as pain-relievers in an ethical framework, and suggests that physicians may wish to consider efficacy but also side effects, contextualization (availability and costs) and patient's requests, according also to the suggestions of the Society for Integrative Oncology (tolerate, control efficacy and side effects).
authors.affiliation: SS Nephrology ASOU, san Luigi (regione Gonzole 10), Orbassano 10043, Torino, Italy. marti.ferraresi@gmail.com
authors.forename: Martina
authors.initials: M
authors.lastname: Ferraresi
authors.forename: Roberta
authors.initials: R
authors.lastname: Clari
authors.forename: Irene
authors.initials: I
authors.lastname: Moro
authors.forename: Elena
authors.initials: E
authors.lastname: Banino
authors.forename: Enrico
authors.initials: E
authors.lastname: Boero
authors.forename: Alessandro
authors.initials: A
authors.lastname: Crosio
authors.forename: Romina
authors.initials: R
authors.lastname: Dayne
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rosset
authors.forename: Andrea
authors.initials: A
authors.lastname: Scarpa
authors.forename: Enrica
authors.initials: E
authors.lastname: Serra
authors.forename: Alessandra
authors.initials: A
authors.lastname: Surace
authors.forename: Alessio
authors.initials: A
authors.lastname: Testore
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Colombi
authors.forename: Barbara Giorgina
authors.initials: BG
authors.lastname: Piccoli
mesh_terms: D000529:Complementary Therapies / Q000941:ethics / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000941:ethics*; D006801:Humans; D006435:Renal Dialysis / Q000941:ethics*; D019124:Therapeutic Touch / Q000941:ethics* / Q000706:statistics & numerical data*; D016896:Treatment Outcome